Behavioral and Social Research

A goal of NIA behavioral and social research is to maintain or enhance the health and well-being, including physical and cognitive function, of older individuals throughout the lifespan. For example, new interventions are being developed to encourage long-term changes in health behaviors that will lead to reduced risk of disease and disability. Cognitive interventions are being tested to maintain cognitive function and retain independence. Components of the physical environment are being redesigned to match the skills and abilities of older persons, thus helping to prevent injuries and to improve performance of daily activities. Such human factors research has produced new and improved medical devices and treatment regimens, instructional designs, and product labeling. As more older people are able and willing to work well into late adulthood, researchers are studying the physical and social barriers to their sustained participation in the workforce and the factors needed to enhance their skills and productivity. A related body of demographic research documents trends in health, retirement, long-term care, and the economic aspects of aging, and uncovers their causes and interrelationships.

Science Advances—Behavioral and Social Research

Social and Productive Activities Confer Survival Advantages to the Elderly. When previous studies found that older people who remained active lived longer, scientists assumed that the survival advantage resulted from improved cardiopulmonary fitness attributable to physical activity. A new study suggests that social activities (church attendance, travel, etc.) and productive activities (gardening, community work, etc.) involving little or no enhancement of fitness lowered the risk of all-cause mortality over a 13-year period to a degree similar to that achieved by fitness activities (e.g., swimming, and walking). This study suggests that a wider range of mechanisms, both psychological and psychosocial, may be involved in the association between activity and mortality than had been previously thought. This finding has important implications for public policy and clinical practice. If confirmed, it suggests that clinicians might consider recommending a broader range of activity options for older patients.

Centenarians Live Most of Their Lives in Good Health. Scientists have found preliminary evidence that many centenariansremain functionally independent for the vast majority of their lives and then experience a relative rapid decline near the end of their lives. Relative to others in the older population, they also appear to either experience a marked delay in the onset or, in some cases, escape diseases such as cancer and Alzheimer’s disease. Scientists also find a strong familial component to extreme longevity. Siblings of centenarians tend to live longer compared to siblings of individuals who died in their mid-70’s. This may be due in part to shared genetic traits among family members. Understanding the genetic and environmental factors responsible for centenarians’ prolonged good health could provide insights for improving the health of all older people. Further work is needed to elucidate the genetic and environmental factors that contribute to centenarians’ extreme longevity.

Socioeconomic Status and Health Disparities Are Strongly Related Over the Life Course. There is a striking and well-documented relationship between socioeconomic status, health, and longevity. People with higher incomes and more wealth tend to be healthier and to live longer. The causes of this relationship are largely unknown, but have been assumed to be related to health behaviors and access to care. In a recent study, African-American men were found to have lower life expectancy in disparate income groups than did white men in the same income groups for the years 1979 to 1989. African-American men with family incomes below $10,000 averaged 7.4 fewer years of life than black men in families with more than $25,000; among white men, the differential between the two income groups was 6.6 years. Less work has been focused on the effect of health events on subsequent income and wealth. The strong interrelationship between health and wealth at older ages may be due, in large part, to the adverse economic impact of major health events. One major reduction in wealth appears to be reduced earnings that stem from taking early retirement or otherwise decreasing work. People who have heart attacks, strokes, or other acute health events are especially likely to reduce their work levels. There are equally large reductions in wealth among those with and without health insurance (although those with health insurance have lower out-of-pocket medical expenses), suggesting that health insurance does not fully protect people from the economic costs of major illnesses. This finding demonstrates how differences in health status can cause differences in economic circumstances. These results also suggest some direction for policy. They show, for example, that health insurance deals with only a small part of the economic cost of declining health. The much larger economic costs of decreased work and lost earnings might be more effectively addressed in other ways. To aid in understanding this causal relation between health and wealth, future clinical trials could include more economic content so that the impacts of health on economic status can be measured.

Neighborhood and Socioeconomic Characteristics Hamper Progress in Fitness. Physical inactivity is a leading cause of both death and disability among older adults. Recent analyses from the Alameda County Study show that socioeconomic variables such as neighborhood characteristics affect physical activity levels and thus may contribute to health disparities. Living in a poor neighborhood is associated with a decline in physical activity, even adjusting for age, individual income, education, smoking status, body mass index, and alcohol consumption. Other survey analyses reveal that poor weather and fear of crime were majors barriers to exercise among low income urban older adults, as was the lack of information from physicians and family/friends regarding the safety and benefits of exercise. These studies demonstrate the importance of designing physical activity/exercise programs that can counter the negative effects of disadvantaged social conditions.